Research Interests: Cognitive Science, Motor Control, Manual Therapy, Cerebral Palsy, Medicine, and 15 moreClinical Practice, Humans, Child, Biomedical Research, Hemiplegia, Infant, Disability and Health, Hand, Botulinum Toxin, International Classification of Functioning, Goal Attainment Scaling, Motor Skills, Canadian Occupational Performance Measure, Functional Laterality, and Modified ashworth scale
Background: Cerebral palsy (CP) is a central nervous system deficit resulting from a non-progressive lesion in the developing brain. Although the brain lesions are static, the movement disorders that arise are not unchanging and are... more
Background: Cerebral palsy (CP) is a central nervous system deficit resulting from a non-progressive lesion in the developing brain. Although the brain lesions are static, the movement disorders that arise are not unchanging and are characterised by atypical muscle tone, posture and movement (Rang 1990). The spastic motor type is the most common form of CP and its conventional therapeutic management may include splinting/casting, passive stretching, facilitation of posture and movement, spasticity-reducing medication and surgery. More recently, health care professionals have begun to use botulinum toxin A (BtA) as an adjunct to interventions in an attempt to reduce muscle tone and spasticity to improve function Objectives: To assess the effectiveness of intramuscular BtA injections as an adjunct to managing the upper limb in children with spastic CP. Search strategy: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), MEDLINE (1966 to March Week 3 2004), EMBASE (1980 to 2003 Week 16) and CINAHL (1982 to Week 3 March 2004). Selection criteria: All randomised controlled trials (RCTs) comparing intramuscular BtA injections into any muscle group of the upper limb with placebo, no treatment or other interventions. Data collection and analysis: Two authors using standardised forms extracted the data independently. Each trial was assessed for internal validity with differences resolved by discussion. Data was extracted and entered into RevMan 4.2.3. Main results: Two trials met the inclusion criteria, each having short-term follow up, a small number of subjects and using a single set of injections. The study by Corry 1997 compared BtA with an injection of normal saline and found promising results in elbow extension, elbow and wrist muscle tone. At three months, encouraging results for wrist muscle tone and grasp and release were noted. The trial reported median change, range of changes and the difference in these measures between groups. The study by Fehlings 2000 compared BtA with no intervention. When data were analysed no treatment effect was found for quality of upper limb function, passive range of motion, muscle tone, grip strength or self-care ability. Reviewers' conclusions: This systematic review has not found sufficient evidence to support or refute the use of intramuscular injections of BtA as an adjunct to managing the upper limb in children with spastic cerebral palsy. Only one of the two identified RCTs reported some promising results in support of reduced muscle tone following BtA injections. Further research incorporating larger sample sizes, rigorous methodology, measurement of upper limb function and functional outcomes is essential.
Research Interests:
Research Interests: Cerebral Palsy, Adolescent, Medicine, Physical Medicine and Rehabilitation, Humans, and 13 moreChild, Arm, Infant, Reviews, Newborn Infant, Adjunct, Upper Extremity, Botulinum Toxin, Randomized Controlled Trials as Topic, Child preschool, Muscle spasticity, Spastic cerebral palsy, and Medical and Health Sciences
Research Interests:
Research Interests:
Research Interests: Family, Cerebral Palsy, Adolescent, Medicine, Physical Medicine and Rehabilitation, and 15 moreLogistic Regression, Humans, Child, Bicycling, Female, Male, Developmental disabilities, Parents, Age Factors, Chi Square Distribution, Logistic Models, Motor Skills, Case Control Studies, Severity of Illness Index, and Medical and Health Sciences
Research Interests:
Research Interests:
Research Interests:
Cerebral palsy (CP) is a central nervous system deficit resulting from a non-progressive lesion in the developing brain. Although the brain lesions are static, the movement disorders that arise are not unchanging and are characterised by... more
Cerebral palsy (CP) is a central nervous system deficit resulting from a non-progressive lesion in the developing brain. Although the brain lesions are static, the movement disorders that arise are not unchanging and are characterised by atypical muscle tone, posture and movement (Rang 1990). The spastic motor type is the most common form of CP and its conventional therapeutic management may include splinting/casting, passive stretching, facilitation of posture and movement, spasticity-reducing medication and surgery. More recently, health care professionals have begun to use botulinum toxin A (BtA) as an adjunct to interventions in an attempt to reduce muscle tone and spasticity to improve function To assess the effectiveness of intramuscular BtA injections as an adjunct to managing the upper limb in children with spastic CP. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), MEDLINE (1966 to March Week 3 2004), EMBASE (1980 to 2003 Week 16) and CINAHL (1982 to Week 3 March 2004). All randomised controlled trials (RCTs) comparing intramuscular BtA injections into any muscle group of the upper limb with placebo, no treatment or other interventions. Two authors using standardised forms extracted the data independently. Each trial was assessed for internal validity with differences resolved by discussion. Data was extracted and entered into RevMan 4.2.3. Two trials met the inclusion criteria, each having short-term follow up, a small number of subjects and using a single set of injections. The study by Corry 1997 compared BtA with an injection of normal saline and found promising results in elbow extension, elbow and wrist muscle tone. At three months, encouraging results for wrist muscle tone and grasp and release were noted. The trial reported median change, range of changes and the difference in these measures between groups. The study by Fehlings 2000 compared BtA with no intervention. When data were analysed no treatment effect was found for quality of upper limb function, passive range of motion, muscle tone, grip strength or self-care ability. This systematic review has not found sufficient evidence to support or refute the use of intramuscular injections of BtA as an adjunct to managing the upper limb in children with spastic cerebral palsy. Only one of the two identified RCTs reported some promising results in support of reduced muscle tone following BtA injections. Further research incorporating larger sample sizes, rigorous methodology, measurement of upper limb function and functional outcomes is essential.
Research Interests:
Research Interests: Decision Making, Assessment, Cerebral Palsy, Adolescent, Activities of Daily Living, and 15 moreChild, Back Pain, Arm, Complex Regional Pain Syndrome, Clinical Sciences, European, Adult, Adverse Event, Assessment Tool, Botulinum Toxin, Analgesics, Cervical Dystonia, Clinical Trials as Topic, Disability Evaluation, and Deglutition disorders
Research Interests:
Research Interests: Occupational Therapy, Treatment Outcome, Cerebral Palsy, Exercise therapy, Medicine, and 13 moreHumans, Child, Male, Hemiplegia, Infant, Upper Extremity, Exercise Test, Injections, Combined Modality Therapy, Neuropsychological Tests, Disability Evaluation, Child preschool, and Medical and Health Sciences
Research Interests: Demography, Medicine, Comorbidity, Humans, Diabetes mellitus, and 15 moreFemale, Male, Anemia, Length of Stay, Clinical Sciences, Aged, Middle Aged, Adult, Neoplasms, Age Factors, Chronic obstructive pulmonary disease, Cardiovascular Diseases, Pressure Ulcer, Cross Infection, and Patient readmission
... admixtures for use in an implantable infusion pump Balvant R. Sitaram b,,, Michael Tsui a, H Barry Rawicki a, Skip Lam a, Pauline ... Ochs, G., Struppler, A., Meyerson, BA, Linderoth, B., Gy bels, J., Gardner, BP, Teddy, P., Jamous,... more
... admixtures for use in an implantable infusion pump Balvant R. Sitaram b,,, Michael Tsui a, H Barry Rawicki a, Skip Lam a, Pauline ... Ochs, G., Struppler, A., Meyerson, BA, Linderoth, B., Gy bels, J., Gardner, BP, Teddy, P., Jamous, A. and Wein man, P., Intrathecal baclofen for long ...
Research Interests:
this study was therefore to examine the prevalence of various lifestyle-related chronic diseases in a population-representative sample of individuals with CP. Study Design: Cross sectional study. Study Participants and Setting: A... more
this study was therefore to examine the prevalence of various lifestyle-related chronic diseases in a population-representative sample of individuals with CP. Study Design: Cross sectional study. Study Participants and Setting: A population-representative sample was obtained using the 2002–2011 Medical Expenditure Panel Survey (MEPS). The analyses included a sample of 215 107 individuals, aged 18 years and older. Of those, 1161 individuals had an ICD-9-CM Diagnosis Code for CP. Materials/Methods: Weighted cross-sectional and multivariate generalized linear models were used to estimate prevalence of chronic diseases among adults with and without CP, using the Household Component and Condition Files of the MEPS. The primary chronic disease outcomes of interest were type 2 diabetes, asthma, hypertension and other cardiovascular conditions (e.g., coronary artery disease), stroke, emphysema, and arthritis. Results: Adults with CP had significantly higher prevalence of all chronic conditi...
Background and Objective(s): Competence in performing advanced gross motor skills can influence a child’s participation in play/sports-based activities. There has been little emphasis on creating an evaluative measure to assess these... more
Background and Objective(s): Competence in performing advanced gross motor skills can influence a child’s participation in play/sports-based activities. There has been little emphasis on creating an evaluative measure to assess these higher level skills in children with cerebral palsy (CP). The Gross Motor Function Measure (GMFM) is the international standard for assessing gross motor function, but was not intended to evaluate advanced motor skills. The Challenge (1,2) was developed to address this measurement gap with children in GMFCS Levels I and II. After initial experience with using the 25-item Challenge, our clinical research team realized that a similar measure for children who use gait aids (GMFCS III) would also be beneficial, and, with permission of the Challenge’s developers, created the Challenge-III. The ultimate aim of this first phase of Challenge-III development was to pilot test it within a gross motor camp assessment to get a sense of both testing feasibility and ...
Research Interests:
Purpose Botulinum toxin-A (or Botox) is widely used for the management of equinus gait in children with cerebral palsy but few recent studies have included instrumented gait analysis. Methods This was a prospective cohort study. Gait... more
Purpose Botulinum toxin-A (or Botox) is widely used for the management of equinus gait in children with cerebral palsy but few recent studies have included instrumented gait analysis. Methods This was a prospective cohort study. Gait analysis was performed four weeks before and four weeks after Botulinum toxin-A injection for spastic equinus to detect the maximum effects on gait kinematics. Outcome measures included the Gait Profile Score (GPS), the Gait Variable Score (GVS) for the ankle, maximal ankle dorsiflexion and maximal knee extension at midstance. Results In all, 37 children participated (20 boys); mean age five years seven months (4 years 1 month to 8 years 2 months); 19 with unilateral and 18 bilateral involvement. At a mean four weeks post-injection, the GPS and ankle GVS were unchanged. However maximum ankle dorsiflexion increased for the whole group; median 7.7° (confidence interval (CI) 4° to 10.6°) to 11.5° (CI 7.7° to 12.9°), p = 0.02. Maximum midstance knee extensi...
Research Interests:
This study aimed to determine the impact of multiple doses of whole-body vibration on heel strike, spatial and temporal gait parameters, and ankle range of motion of children with idiopathic toe walking. Whole-body vibration was applied... more
This study aimed to determine the impact of multiple doses of whole-body vibration on heel strike, spatial and temporal gait parameters, and ankle range of motion of children with idiopathic toe walking. Whole-body vibration was applied for 5 sets of 1 minute vibration/1 minute rest. Gait measures were collected pre intervention, 1, 5, 10, and 20 minutes postintervention with the GaitRite(®)electronic walkway. Ankle range of motion was measured preintervention, immediately postintervention, and 20 minutes postintervention. The mean (SD) age of the 15 children (n = 10 males) was 5.93 (1.83) years. An immediate increase in heel contact (P= .041) and ankle range of motion (P= .001 andP= .016) was observed. These changes were unsustained 20 minutes postvibration (P> .05). The gait improvement from whole-body vibration could potentially be due to a rapid increase in ankle range of motion or a neuromodulation response.
Research Interests:
Nontraumatic spinal cord injury rehabilitation: pressure ulcer patterns, prediction, and impact 1 1 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the...more
Background Many previous studies that have investigated hospital admissions in children and young people with cerebral palsy lack information on cerebral palsy severity and complexity. Consequently, little is known about factors... more
Background Many previous studies that have investigated hospital admissions in children and young people with cerebral palsy lack information on cerebral palsy severity and complexity. Consequently, little is known about factors associated with the frequency and type of hospital admissions in this population. This study used hospital admission data available for all children and young people known to a population-based cerebral palsy register to describe the patterns of use of tertiary paediatric hospital services over a 5-year period.Methods This was a retrospective cohort analysis of routinely collected admission data from the two tertiary paediatric hospitals in the Australian state of Victoria. Data on admissions of individuals born between 1993 and 2008 registered on the Victorian Cerebral Palsy Register were analysed (n = 2183).ResultsBetween 2008 and 2012, 53% of the cohort (n = 1160) had at least one same-day admission, and 46% (n = 996) had one or more multi-day admissions....
Research Interests:
A 34-year-old quadriplegic man with a C6/C7 spinal cord lesion of 10 years' duration fathered a child with his 35-year-old wife who had undergone a premature menopause 10 years earlier. Pregnancy was achieved from in-vitro... more
A 34-year-old quadriplegic man with a C6/C7 spinal cord lesion of 10 years' duration fathered a child with his 35-year-old wife who had undergone a premature menopause 10 years earlier. Pregnancy was achieved from in-vitro fertilization of two oocytes donated by the wife's sister using spermatozoa from the husband obtained by repeated electro-ejaculation techniques. A healthy male infant weighing 2250 g was delivered by Caesarean section at 37 weeks following mild pre-eclampsia.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
ABSTRACT We have found that the simultaneous intrathecal infusion of low concentrations of baclofen and morphine are of significant benefit in the treatment of both severe pain and spasticity. To extend the range of drug concentrations... more
ABSTRACT We have found that the simultaneous intrathecal infusion of low concentrations of baclofen and morphine are of significant benefit in the treatment of both severe pain and spasticity. To extend the range of drug concentrations for clinical use, the stability and physical compatibility of baclofen and morphine sulphate admixtures containing high concentrations of baclofen and morphine sulphate have been examined. The studies reported demonstrate that baclofen and morphine in the admixtures examined were stable for at least 30 days when stored at 37°C. 4-(4-chlorophenyl)-2-pyrrolidone, a degradation product of baclofen was detected in all admixtures examined. Its concentration remained less than 1% of that of baclofen throughout the period of storage. Morphine-N-oxide, a potential degradation product of morphine, could not be detected in any of the admixtures examined. While the use of a highly sensitive and selective liquid chromatographic technique with on-line fluorescence detection revealed the presence of pseudomorphine and its time-dependent increase on storage, its concentration also constituted less than 1% of the parent drug.
Research Interests:
Research Interests:
The aims of this study were to (1) determine whether an instrumented measure will reduce measurement error to less than 5° in children with cerebral palsy (CP), (2) determine agreement and reliability of this instrumented measure in both... more
The aims of this study were to (1) determine whether an instrumented measure will reduce measurement error to less than 5° in children with cerebral palsy (CP), (2) determine agreement and reliability of this instrumented measure in both conscious and anaesthetized participants, and (3) compare the method with previously reported measures. Thirty-four ambulant children (15 males, 19 females), aged 3 to 9 years, with spastic CP were studied in a tertiary-care paediatric hospital (21 with hemiplegia, 11 with diplegia, and two with quadriplegia). The majority of children functioned at Gross Motor Function Classification System level I (n=11) or II (n=18), with five children at level III. Ankle dorsiflexion at 50% bodyweight was photographed and measured. Each child was measured when conscious and when under mask anaesthesia by two experienced assessors. The standard error of measurement (SEM) ranged from 3.9° (anaesthetized; 95% confidence interval [CI] 3.3-4.0°) to 6.7° (conscious; 95% CI 5.3-8.0°). This compared favourably with previously reported dorsiflexion measures (SEM range 6.5-7.8°) in conscious children with CP. Intrarater reliability was good in both conditions (intraclass correlation coefficient [ICC]: range 0.95 [anaesthetized; 95% CI 0.92-0.98] to 0.86 [conscious; 95% CI 0.76-0.95]). The ICC for interrater reliability ranged from 0.87 (anaesthetized; 95% CI 0.81-0.93) to 0.65 (conscious; 95% CI 0.50-0.81). Passive ankle dorsiflexion using an instrumented measure has face validity and may assist in the improvement of reproducibility under anaesthesia for clinical research. When an individual is conscious, this technique is not better than trained assessors using conventional goniometry reported in the literature and is not recommended for routine clinical use.
Research Interests:
Research Interests: Cognitive Science, Communication, Magnetic Resonance Imaging, Australia, Epilepsy, and 15 moreCerebral Palsy, Activities of Daily Living, Gait, Brain, Humans, Female, Male, Infant, Developmental disabilities, Age Factors, Community Health Planning, Cohort Studies, Motor activity, Disability Evaluation, and Child preschool
Research Interests: Cognitive Science, Motor Control, Manual Therapy, Cerebral Palsy, Clinical Practice, and 15 moreHumans, Child, Biomedical Research, Hemiplegia, Infant, Disability and Health, Hand, Botulinum Toxin, International Classification of Functioning, Canadian Occupational Performance Measure, Functional Laterality, Combined Modality Therapy, Child preschool, Modified ashworth scale, and functional outcome
Object. The goal of this study was to assess the long-term benefits of managing severe spasticity by using continuous infusion of intrathecal baclofen delivered via an implantable pump.Methods. Eighteen patients with severe spasticity of... more
Object. The goal of this study was to assess the long-term benefits of managing severe spasticity by using continuous infusion of intrathecal baclofen delivered via an implantable pump.Methods. Eighteen patients with severe spasticity of cerebral origin, who failed to respond adequately to more conservative treatments, have been treated with continuous infusion of intrathecal baclofen delivered via an implanted pump. Follow-up review of these patients has lasted between 12 months and 9 years. The patients have been assessed using a variety of tools. Seventeen have had a significant reduction in tone and all have benefited by a reduced need for nursing care or increased function or both.Conclusions. Long-term continuous infusion of intrathecal baclofen delivered via an implantable pump offers an effective method for dealing with otherwise intractable spasticity.
Research Interests:
Research Interests:
To investigate the characteristics, predictors, and consequences of pressure ulcers in patients with nontraumatic spinal cord injury (SCI). Retrospective, 3-year, case series. Tertiary medical unit specializing in SCI rehabilitation.... more
To investigate the characteristics, predictors, and consequences of pressure ulcers in patients with nontraumatic spinal cord injury (SCI). Retrospective, 3-year, case series. Tertiary medical unit specializing in SCI rehabilitation. Consecutive sample of 134 adult inpatient referrals with nontraumatic SCI. Patients requiring initial rehabilitation or readmission were included. Chart review. Primary outcome measures were presence of pressure ulcers on admission to rehabilitation, incidence of new pressure ulcers developing during hospitalization, and any complications attributable to pressure ulcers during inpatient rehabilitation. Secondary objectives were to examine the predictability of risk factors for pressure ulcers, to assess the usefulness of a model previously developed for predicting pressure ulcers in patients with chronic SCI, and to estimate the effect of pressure ulcers on rehabilitation of nontraumatic SCI. Prevalence of pressure ulcers among admissions was 31.3% (n=42). Only 2.2% (n=3) of patients developed a new pressure ulcer after admission. The length of stay (LOS) of patients admitted with a pressure ulcer was significantly longer than that of those without a pressure ulcer (geometric mean, 62.3 d for pressure ulcer vs 28.2 d for no pressure ulcer, P=.0001). Many previously identified risk factors for pressure ulcers in SCI patients did not apply to our nontraumatic SCI patients. It is estimated that the inpatient LOS for those patients with a significant pressure ulcer was increased by 42 days. Pressure ulcers are a common complication for people with nontraumatic SCI who are admitted for rehabilitation, and they have a significant impact on LOS.
Research Interests: Prediction, Spinal Cord Injury, Medicine, Humans, Female, and 14 moreSpinal Cord, Male, Orthopedics, Regression Analysis, Risk factors, Length of Stay, Clinical Sciences, Aged, Middle Aged, Public health systems and services research, Retrospective Studies, Risk Factors, Pressure Ulcer, and Spinal Cord Injuries
Research Interests: Demography, Medicine, Comorbidity, Humans, Diabetes mellitus, and 15 moreFemale, Male, Anemia, Length of Stay, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Neoplasms, Age Factors, Chronic obstructive pulmonary disease, Cardiovascular Diseases, Pressure Ulcer, and Cross Infection
A 34-year-old paraplegic man with a spinal cord injury complete below the 6th thoracic segment fathered a child by artificial insemination using semen obtained by electro-ejaculation. A long fertility programme culminated in the delivery... more
A 34-year-old paraplegic man with a spinal cord injury complete below the 6th thoracic segment fathered a child by artificial insemination using semen obtained by electro-ejaculation. A long fertility programme culminated in the delivery of a healthy male child weighing 3665 g in April 1987. Guidelines for a comprehensive fertility programme are discussed briefly.
Research Interests:
Research Interests:
To examine the association between parent-reported ability of young children with cerebral palsy (CP) to eat different food textures and gross motor functional abilities. Prospective, longitudinal, representative cohort study. Community... more
To examine the association between parent-reported ability of young children with cerebral palsy (CP) to eat different food textures and gross motor functional abilities. Prospective, longitudinal, representative cohort study. Community and tertiary pediatric hospital settings. Children (N=170; 110 boys [65%]) were assessed on 396 occasions (range, 1-4 occasions), including 67 at 1 year 6 months (49 boys), 99 at 2 years (66 boys), 111 at 2 years 6 months (71 boys), and 119 at 3 years (64 boys). Not applicable Gross motor function was determined using the Gross Motor Function Classification System (GMFCS). Parent-reported eating ability was determined using 4 items of the Pediatric Evaluation of Disability Inventory. The association between capability to eat food textures and GMFCS level was examined using generalized estimating equations. The distribution of GMFCS levels at initial presentation was as follows: I, n=62; II, n=32; III, n=24; IV, n=22; and V, n=30. Reported capability to eat cut-up/chunky and "all textures" of table foods decreased significantly as GMFCS level increased. A decreased capability to eat pureed/blended and ground/lumpy foods compared with GMFCS I was significantly associated with GMFCS levels IV and V only. Reported attainment of eating skills was closely associated with GMFCS level in young children with CP across age levels. These results emphasize the need for early oral-motor and feeding screening in young children with CP across gross motor functional abilities.
Research Interests:
To investigate the relationship between motor ability and early social development in a cohort of preschool children with cerebral palsy (CP). Population-based cohort study. Participants were 122 children with CP assessed at 18, 24 and 30... more
To investigate the relationship between motor ability and early social development in a cohort of preschool children with cerebral palsy (CP). Population-based cohort study. Participants were 122 children with CP assessed at 18, 24 and 30 months, corrected age (ca). Motor ability was measured by the Gross Motor Function Classification System (GMFCS) with classification assigned by physiotherapists. The sample was representative of a population-based cohort (I=48, 38.4%, II=19, 15.2%, III=17, 13.6%, IV=22, 17.6% and V=19, 15.2%). Social development was measured by the Paediatric Evaluation of Disability Inventory (PEDI) and included capabilities in social interaction, social communication, interactive play and household/community tasks. Cross-sectional analyses indicated a significant relationship between motor ability and social development at 18 months, F(4, 56)=11.44, p<.0001, η(2)=.45, at 24 months, F(4, 79)=15.66, p<.0001, η(2)=.44 and at 30 months, F(4, 76)=16.06, p<.0001, η(2)=.49. A longitudinal analysis with a subset of children (N=24) indicated a significant interaction between age at assessment and GMFCS, F(2, 21)=7.02, p=.005, η(2)=.40. Comparison with community norms indicated that at 18 months corrected age, 44.3% of the cohort was greater than two standard deviations below the mean (>2SD) for social development and a further 27.9% of the cohort was greater than one standard deviation below the mean (>1SD). There is a relationship between motor ability and social development in preschool children with CP. Children with CP may require support for social development in additional to physical interventions, from as early as 18 months.